Spondyloarthritis Flashcards
How is spondyloarthropathy categorized / what are the types of spondyloarthritis?
Axial and peripheral
Axial:
- Radiologically axial spondyloarthritis (ank spond)
- Non radiologically active spondyloarthritis
Peripheral:
- Psoritic arthritis
- IBD associated arthritis
- reactive arthritis
What is the new term for ank spond?
Axial spondyloarthritis
What is the male to female ration in ank spond?
2:1
Pt has clinical features of anylosing spoindylitis. NIl XR changes but there is inflammation on MRI. What condition?
Non radiological axial spondyloarthritis
- Other manifestations include uvewitis, urethritis etc
What is the most common extra intyestinal manifestation of a IBD?
spondyloarthritis
What is classified as inflammatory back pain / typical presentation?
Young age
Insidious onset
Improvement with exercise
NIl improvement with rest
Pain at night
What percentage of HLA B27 get spondyloarthritis?
20%, most dont
Where does inflamation begin in the pathogenesis of spondyloarthropathies?
Enthesis
Which are the main cytokines in spondyloarthritis? WHich of these induce bone destruction?
TNF alphas, IL 23, IL 17
- TNF and IL 17 induce bone destruction
IL17 made by TH17 cells in response to IL 23
What is a thought to be a key feature in spondyloarthritis pathogenesis?
Skin or gut barrier breakdown
What is a key unifying XR finding (if present) that is reasonably specific for spondyloarthritis?
New bone formation
What spondyloarthritis agents are contraindicated in pts with IBD?
IL17 agents (IL17 is improtant in protection from gut infection in pts with gut breakdown)
Examples:
- Brodalumab
Aside from back pain, what other clinical features of ank spond?
Large joint oligoarthritis
Enthesitis (achilles tendon most common)
Achiles or plantar fascitis
Dactylitis (sausage fingers)
Uveitis
What is the most common extraarticular manifestation of ank spond?
Uveitis (acute monocular anterior uveitis)
What is Rx for ank spond?
Exersise and NSAIDs first line
If fails these then biologicz
What are typical findings of axial spondyloarthritis on XR?
Hip XR:
- Narrowing or loss of the sacroiliac joint lines (fusion=ankylosis)
- Irregular joint line, sclerosis (more white stuff)
Lumbar spine:
- Squaring the the vertebral bodies
- Syndesmophytes (cross linking between vertebral bodies
- Bamboo spine if all ankylosed
Does dactylitis (sausage finger) occur in other forms of spondyloarthris aside from psoriatic?
Yes
Which spondyloarth does HLA B27 confer teh highest risk of?
Ank spond
What is the HLA associated with Psoriatic arthritis?
HLA C06*02
- can also have HLA B27 but less
What is the main complication / associated condition with psoiriatic arthritis?
Cardiovascdular disease
- obesity is often present
What pattern of psoriasis skin involvment confers highest risk fo developing psoriatic arthritis?
Scalp, genital or nail involvment
What is the main difference between the small joint arthritis in PS vs RA?
DIP involvement and nail change DO NOT occur in RA
this would be PA
What are the classic XR findings in PA?
pencil in cup deformity (responsible for the clinical telescoping of severe PA)
What are some features of reative arthritis?
keratoderma blennorrhagicum
- THicken patches or spots of keratosis over the soles of the feet
Migratory glossitis
- SHifting qhite tongue plaques
Circinate balanitis
-m White plaque like inflamation of the head of penis
Can also get uveitis, urethritis and ofc arthritis (can see, cant pee, cant climb a tree)
Can reactive arthritis occur post STIs?
Yes it can
What is Rx of reactive arthritis?
Treat infection
SYmptom managment with NSAID +/- joint injections
Sulfasalizine
Is post strep arthritis different from reactive arthritis?
It is different
What is management for IBD assocaited arthritis?
Treat IBD
